Organization Active NPI

Stephen a. White, M.D., P.C.

  • Internal Medicine Physician
  • Clarksville, TN
National Provider Identifier
1114946290
Registry record updated May 24, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD14198 Issued in TN
Legal business name
STEPHEN A. WHITE, M.D., P.C.
Practice address
2289 B Rudolphtown Road
Clarksville, TN 37043-4539
Phone
(931) 552-3031
Fax
(931) 552-9820
NPI assigned
Jul 19, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 24, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Stephen A White, M.D.NPI 1740487305
Title
President
Phone
(931) 552-3031

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X MD14198 TN Primary

Addresses

Primary practice location

2289 B Rudolphtown Road
Clarksville, TN 37043-4539

Mailing address

2289 B Rudolphtown Road
Clarksville, TN 37043-4539
Phone (931) 552-3031

Other identifiers 2

IdentifierTypeStateIssuer
3153602OtherTNBLUE CROSS
3721373MedicaidTN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20091210000305 TN Part B Supplier - Clinic/Group Practice 2466592167 Receives reassigned benefits from 1 practitioner
Practice locations: Clarksville, TN

National Provider Directory

National Provider Directory

Locations

2289 Rudolphtown Rd
Ste B
Clarksville, TN 37043
Phone (931) 552-3031

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153267200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1337817600000",
    "number": "1114946290",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2289 B RUDOLPHTOWN ROAD",
            "city": "CLARKSVILLE",
            "state": "TN",
            "postal_code": "370434539",
            "telephone_number": "931-552-3031",
            "fax_number": "931-552-9820"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2289 B RUDOLPHTOWN ROAD",
            "city": "CLARKSVILLE",
            "state": "TN",
            "postal_code": "370434539",
            "telephone_number": "931-552-3031",
            "fax_number": "931-552-9820"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STEPHEN A. WHITE, M.D., P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-19",
        "last_updated": "2012-05-24",
        "status": "A",
        "authorized_official_last_name": "WHITE",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "931-552-3031",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "TN",
            "license": "MD14198",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "3153602",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3721373",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Clarksville, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.